Dual coronary embolization associated with atrial fibrillation: a case report

Abstract

Background: Thrombotic occlusion of the coronary artery, which succeeds the atherosclerotic plaque rupture or erosion, gives rise to a major portion of acute myocardial infarction (AMI) incidences. Nevertheless, coronary embolism is gaining increasing recognition as another important factor contributing to AMI. Case presentation: A 72-year-old woman with atrial fibrillation (AF) and diabetes mellitus histories, presented with chest pain radiating to the left arm and shoulder that began 6 hours prior to admission. Electrocardiogram revealed AF plus ST-segment elevation in the anterior leads. Intervention: Patient was first treated with anti-platelet agents (aspirin plus ticagrelor) and atorvastatin. Emergency coronary angiography depicted multi-site coronary embolization of the left circumflex artery (LCX) and the left anterior descending artery (LAD). Blood flow was not restored after intracoronary injection of 600 ug tirofiban. 40 mg recombinant human prourokinase was then administered via aspiration thrombectomy catheter. Outcome: Two weeks later, coronary angiography showed no residual obstructive lesion in the LCX and LAD with TIMI (thrombolysis in myocardial infarction) 3 flow. Conclusion: Primary percutaneous coronary intervention is the most effective measure. In the case of failed blood flow restoration, thrombolytic treatment in both intravenous and intracoronary route should be considered.

Keywords

• Embolization
• Acute myocardial infarction
• Atrial fibrillation
• Thrombolytic treatment